Epidemiological surveillance of bacterial nosocomial infections in the surgical intensive care unit.

INTRODUCTION: Intensive care units (ICUs) are associated with a greater risk of developing nosocomial infections (NIs) than other departments. AIM: The aim of this study was to determine the rate, the site and causative organisms of NIs in the surgical ICU at University Clinical Center Tuzla. METHODS: All patients admitted to the surgical ICU were followed prospectively, for the development of NIs (January-December 2010). Determination of NIs was performed using standardized the Centers for Disease Control and Prevention (CDC) criteria. RESULTS: 94 out of 834 patients (11.27%) developed NIs. Respiratory tract infections were seen in 56 (60%), urinary tract infections in 15 (16%) and gastrointestinal tract infections in 8 (9%) patients. Other infections identified were surgical site, bloodstream and skin infections. Gram-negative organisms were reported in approximately 75% of cases (78.7% extended-spectrum beta-lactamase (ESBL)-producers). Klebsiella pneumoniae was the commonest (51.0%), followed by Proteus mirabilis (21.3%) and Pseudomonas aeruginosa (10.6%). Methicillin-resistant Staphylococcus aureus (MRSA) (16%), and Clostridium difficile (9.6%) were the commonest among gram-positive bacteria. CONCLUSION: Respiratory and urinary tract infections made up the great majority of NIs. ICU patients are more susceptible to NIs, emphasizing the importance of continuous surveillance and enforcement of specific infection control measures.

Epidemiological monitoring of nosocomial infections caused by acinetobacter baumannii.

INTRODUCTION: Acinetobacter baumannii is a frequent cause of infections in hospitals around the world, which is very difficult to control and treat. It is particularly prevalent in intensive care wards. AIM: The main objective of the research was to establish the application of epidemiological monitoring of nosocomial infections (NIs) caused by A. baumannii in order to determine: the type and distribution of NIs, and to investigate antimicrobial drug resistance of A. baumannii. MATERIAL AND METHODS: 855 patients treated at the Clinic of Anesthesiology and Reanimation, University Clinical Center Tuzla during 2013 were followed prospectively for the development of NIs. Infections caused by A. baumannii were characterized by the anatomical site and antibiotics resistance profile. RESULTS: NIs were registered in 105 patients (12.3%; 855/105). The predominant cause of infection was A. baumannii with an incidence of 51.4% (54/105), followed by ESBL-producing Klebsiella pneumoniae with 15.2% (16/105) of cases, methicillin-resistant Staphylococcus aureus with 8.6% (9/105), and ESBL-producing Proteus mirabilis with 7.6% (8/105). According to the anatomical site, and type of NIs caused by A. baumannii, the most frequent were respiratory infections (74.1%; 40/54). Infections of surgical sites were registered in 11.1% (6/54) of cases, while bloodstream infections in 9.2% (5/54). A. baumannii isolates tested resistant against most antibiotics examined, but showed a high degree of susceptibility to tobramycin (87%; 47/54) and colistin (100%; 54/54). CONCLUSION: The increasing incidence of multi- and extensively drug-resistant Acinetobacter spp. emphasizes the importance of administration of an adequate antibiotic strategy and the implementation of strict monitoring of the measures for controlling nosocomial infections.

[Incidence of ARDS in patients with multiple injuries]. / Ucestalost ARDS-a u politraumatizovanih bolesnika.

Adult respiratory distress syndrome (ARDS) is common complication and cause of death in some patients with polytrauma. Twenty patients with polytrauma were in test group and have had revised trauma score (RTS) nine or less. The aim of this study is to establish an incidence of ARDS, mortality rate and significance of Lung injury score (LIS) in assessment of damage of the lung function. In test group, 20% (4 patients) tested have developed ARDS with mortality rate of 25% (one patient dead). LIS is important for quantification and qualification of damage of the lung function. In patients who survived, value of LIS has been decreasing within three days. In patient who deceased, LIS has been continuously more than 2.5 within three days. LIS does not have significance as mortality predictor in cases of non-pulmonary complications such as renal, hepatic and cardiac dysfunction.